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Nursing 172 > Week 10: Chp 40: Assessment of Endocrine Function > Flashcards

Week 10: Chp 40: Assessment of Endocrine Function Flashcards

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1
Q

The Endocrine System includes various glands found in several areas of the body that help with what life-sustaining functions?

A

metabolism, growth and development, blood glucose control, and sexual functioning

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2
Q

What are the Endocrine Glands

A
  • hypothalamus
  • pituitary gland (anterior and posterior)
  • adrenal glands (lay on top of the kidneys)
  • thyroid glands
  • parathyroid glands (sit on the back of the thyroid gland)
  • the gonads
  • select cells of the pancreas (islet cells)
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3
Q

What do the Endocrine Glands do?

A

secrete hormones that are chemical messengers that act on specific target tissues, resulting in physiological function
-underproduction and overproduction of selected hormones are the leading causes of endocrine disorders

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4
Q

Hormones from the endocrine glands are secreted directly into what?

A

directly into the blood system

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5
Q

What are exocrine glands?

A

lacrimal, salivary, and sweat glands and the part of the pancreas that secretes pancreatic juices that are released into the small intestine

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6
Q

Hormones from exocrine glands are released through what?

A

released through the ducts (lacrimal, salivary, and sweat)

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7
Q

The function of the Endocrine System

A

is directly associated with secretion and levels of circulating hormones, and disorders are classified as primary, secondary, tertiary, and quaternary
-closely linked to the nervous system; neuroendocrine regulation

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8
Q

Primary disorders

A

involve actual dysfunction of the endocrine gland

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9
Q

Secondary Disorders

A

refer to the dysfunction of the anterior pituitary gland

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10
Q

Tertiary Disorders

A

refer to dysfunction of the hypothalmaus

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11
Q

Quaternary Disorders

A

refer to the inability of the target tissue to respond to the hormone

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12
Q

Neuroendocrine Regulation

A

the function of the endocrine system is closely linked to the nervous system
-the secretion of hormones is regulated via signals from the nervous system, levels of hormones in the blood, and other chemical changes in the blood such as glucose, sodium, and potassium levels

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13
Q

What glands play an active role in endocrine function?

A

both hypothalamus and pituitary gland

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14
Q

The secretion of hormones is regulated by what?

A
  • signals from the nervous system
  • levels of hormones in the blood
  • other chemical changes in the blood such as blood glucose, sodium, and potassium levels
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15
Q

Hormonal release is controlled by what?

A

a negative feedback system

-increases hormonal secretion when circulating levels are decreased

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16
Q

Negative Feedback System

A

controls hormonal release

-increased hormonal secretion when circulating levels are decreased

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17
Q

Example of Negative Feedback System

A

the hypothalamus releases thyrotropin-releasing hormone (TRH) when there are decreased levels of thyroid hormones; triiodothyronine (T3) and thyroxine (T4) circulating in the blood stream
-in turn, the TRH acts on its target gland, the anterior pituitary gland, and thyroid-stimulating hormone (TSH) is released
-the target gland for TSH is the thyroid gland, which releases T3 and T4
>while levels of circulating T3 and T4 increase, the feedback to the hypothalamus is to decrease secretion of TRH

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18
Q

Safety Alert: Why do patients who are prescribed corticosteroids for more than 10 to 14 days require “tapering” of the medication?

A

because of the effects of the exogenous corticosteroid on the hypothalamus, anterior pituitary, and adrenal cortex, the normal hormonal feedback system is interrupted; abrupt withdrawal of the exogenous drug may lead to adrenal insufficiency, which is a medical emergency characterized by decreased blood pressure and hypoglycemia

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19
Q

Hormones are also influenced by intrinsic factors

A

as part of the stress response, cortisol secretion is increased to assist the body in dealing with stresses such as trauma, infection, and disease
-additionally, when patients are prescribed certain medications such as corticosteroids for inflammation, these exogenous agents impact the function of the negative feedback system
>because there are increased circulating levels of corticosteroid, the hypothalamus decreases secretion of corticotropin-releasing hormone; this in turn leads to decreased secretion of adrenocorticotropic hormone (ATCH) from the anterior pituitary gland, which results in decreased secretion of cortisol from the adrenal cortex
>these coordinated activities between the nervous system and endocrine glands assist in maintaining homeostasis

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20
Q

What glands play a key role in the feedback system that regulates homeostasis?

A

hypothalamus and pituitary gland

-it is known as hypothalamic-pituitary system or complex

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21
Q

Hypothalamus

A

small structure located beneath the thalamus

  • shaped like a flattened funnel and forms the walls and floor of the third ventricle in the brain
  • hormones produced and secreted act directly on other endocrine glands
  • Hormones secreted: corticotrophin-releasing hormone, gonadotropin-releasing hormone (GnRH), growth hormone-releasing hormone (GHRH), growth hormone-inhibiting hormone (somatostatin; GHIH), thyrotropin-releasing hormone (TRH), and prolactin-inhibiting hormone
  • Hormones Target tissue: Anterior Pituitary Gland
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22
Q

What is the hypothalamus’s Target tissue when secreting hormones?

A

Anterior Pituitary Gland

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23
Q

Pituitary Gland

A

located at the base of the brain in the sella turcica, a depression of the sphenoid bone, and the size of a lima bean

  • communicates directly with the hypothalamus
  • composed of 2 lobes: the anterior lobe (adenohypophysis) and the posterior lobe (neurohypophysis), which have distinct functions
  • the hypothalamus regulates anterior pituitary gland function through the secretion of hormones
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24
Q

What regulates the anterior pituitary gland function?

A

the hypothalamus

-the anterior pituitary gland is the hypothalamus’s target tissue

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25
Q

Anterior Pituitary Secretes What Hormones?

A

-2 gonadotropins (FSH) and (LH), which stimulate the gonads:
>Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that have major roles in female and male reproductive functions
-Thyroid-stimulating hormone (TSH); works directly on thyroid glands releasing thyroid hormones
-Adrenocorticotropic hormone (ACTH); stimulates the release of glucocorticoids and mineralocorticoids from the adrenal cortex
-Prolactin; milk formation
-Growth Hormone (GH, somatotropin); facilitates growth of bones and tissues and protein synthesis
-Melanocyte-stimulating hormone; targets melanocytes that increases pigmentation (skin and hair color)

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26
Q

Posterior Pituitary Gland

A

composed of nerve tissue that arises in the hypothalamus; these nerve fibers are responsible for neuroendocrine reflexes that result in hormone secretion in response to signals from the nervous system
Hormones Secreted: Antidiuretic hormone (ADH) and Oxytocin

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27
Q

Hormones Secreted by the Posterior Pituitary Gland

A

These are synthesized by the hypothalamus but are stored and released from the posterior pituitary gland

  • Antidiuretic Hormone (ADH); secreted in response to decreased BP, dehydration, and increased serum osmolality and works by increasing water reabsorption in the kidneys
  • Oxytocin; target tissues are the uterus (causing contractions in labor) and mammary glands (causing milk release)
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28
Q

Adrenal Glands

A

located on top of each kidney
-each adrenal gland has a inner core (the medulla), and thick outer covering (the cortex), both with distinct endocrine functions

29
Q

Adrenal Glands: Adrenal Cortex

A

thick outer covering of the adrenal gland

-Secretes: mineralocorticoids (Aldosterone), and glucocorticoids (Cortisol)

30
Q

Adrenal Gland: Adrenal Cortex secretes which hormones?

A

-Mineralocorticoids; control fluid balance through their effects on the kidney; the target cells are the collecting ducts in the kidney, and stimulation leads to reabsorption of sodium and water and excretion of potassium
>Aldosterone is the primary mineralocorticoid
-Glucocorticoids; have an effect on carbohydrate, protein, and fat metabolism and suppress inflammatory and immune function; also cause reabsorption of sodium and excretion of potassium in the kidneys
>Cortisol is the primary glucocorticoid

31
Q

Adrenal Gland: Adrenal Medulla

A

under the control of the Sympathetic Nervous System (SNS)
-Catecholamines (epinephrine and norepinephrine) are secreted from the adrenal medulla when stimulated by the SNS, and their actions vary according to the receptor sites
>Alpha (alpha1 and alpha2)
>Beta (Beta1 and Beta2 and Beta3)

32
Q

Thyroid Gland

A

located in the anterior neck, lies below the cricoid cartilage
-composed to two lobes, it is connected by a strip of tissue called the isthmus
-Regulates metabolism
-hormones produces: Triiodothyronine (T3), Thyroxine (T4), and thyrocalcitonin (calcitonin)
>production of these hormones requires adequate dietary intake of protein and iodine

33
Q

Thyroid Gland: The release of T3 and T4 are controlled by what?

A

the hypothalamic-pituitary system

-and is based on the circulating levels of these thyroid hormones

34
Q

What happens when T3 and T4 are low?

A

the hypothalamus secretes TRH that stimulates the release of TSH from the anterior pituitary gland
-in turn, TSH acts on the thyroid gland, leading to secretion of T3 and T4; while circulating levels of T3 and T4 increase, the feedback system causes the hypothalamus to decrease the release of TRH

35
Q

Thyroid Hormones T3 and T4 bind to what?

A

are plasma protein bound; important to assess plasma protein levels (albumin) when assessing thyroid function, because an increase in free thyroid hormone may occur in the patient with hypoalbuminemia

36
Q

Specific Actions of Thyroid hormones Triiodothyronine (T3) and Thyroxine (T4)

A

-regulation of metabolic activity
-increased rate and contractility of the heart
-increased rate and depth of respirations
-increased oxygen use
-increased glucose intake by the cells
-increased glycolysis and enhanced gluconeogenesis
-increased protein synthesis and catabolism
-increased mobilization of fatty acids
-increased oxidation of free fatty acids
-decreased cholesterol and phospholipids
>the overall increase in metabolic activity results in increased heat production in all tissues

37
Q

Thyroid Hormones: Thyrocalcitonin

A

(calcitonin)
has a role in the regulation of calcium, along with parathyroid hormone (PTH)
-Serum calcium and phosphorus levels are lowered by the actions of calcitonin on the bones, calcitonin decreases serum calcium levels

38
Q

Bone resorption

A

process involving breakdown of bone through osteoclastic activity that involves secretion of enzymes and acid that dissolve microscopic bits of bone matrix

39
Q

Because Osteoclastic Activity (breakdown/ dissolving of bone) is decreased by calcitonin, what happens?

A

there is less calcium released from the bone into the circulation (calcitonin “tones” down calcium) (calcium deposition is stimulated in bones)

40
Q

The release of calcitonin is regulated by what?

A

by serum calcium levels
-when serum calcium levels are low, calcitonin secretion is inhibited
-when calcium levels are high, secretion of calcitonin is increased
>Calcitonin “tones down” calcium

41
Q

Parathyroid Glands

A

found embedded in the thyroid gland

  • secrete parathyroid hormone (PTH); secreted in response to low calcium levels
  • targets tissues: bones, kidneys, and intestines
42
Q

Parathyroid hormone (PTH) increases serum calcium through the following actions:

A
  • increased bone reabsorption through osteoclastic activity
  • stimulates renal absorption of calcium
  • stimulates activation of vitamin D, which increases intestinal reabsorption of calcium
43
Q

Parathyroid hormone (PTH) affects what other level besides calcium?

A

phosphorus levels

  • reduces reabsorption of phosphate from the proximal tubes in the kidneys, leading to a decrease in serum phosphorus levels
  • increases bone resorption, leading to an increase in phosphorus released from the bone
  • increases small intestine absorption of phosphate
44
Q

Pancreas

A

located in the upper left quadrant of the abdominal cavity, has both exocrine and endocrine functions

  • Exocrine function: involves the secretion of pancreatic juices in the small intestine that aid in digestion
  • Endocrine Function: blood glucose control by the islet cells of the pancreas
  • 2 hormones released: Insulin (released from beta cells) and Glucagon (released from alpha cells)
45
Q

Glucose arrives in the blood from 1 of 3 sources

A
  1. carbohydrates converted to glucose via digestion, and absorbed through the GI tract
  2. glucose released from stored glycogen in muscle and liver cells
  3. glucose newly created (gluconeogenesis) in the liver
46
Q

What happens to glucose once it is in the bloodstream?

A

once in the bloodstream, glucose is transported to the target cell.
-there, insulin facilitates transport of glucose across the cell membrane to the cells interior
-inside the cell, glucose is metabolized as fuel, releasing energy necessary for normal cellular functioning
>without the effective action of insulin, very little glucose would be able to reach the inside of the cell; instead, glucose would remain in the bloodstream, and blood glucose levels would rise

47
Q

Homeostasis of Blood Glucose

A
  • If blood glucose levels are high, more insulin is secreted by the pancreas; blood glucose is then driven into the cells and metabolized and as a result glucose levels in the blood fall
  • If blood glucose levels fall too low, insulin release is suppressed and glucose remains in the bloodstream instead of being driven into the cells; in addition, the hormone glucagon is released from the pancreatic alpha cells; glucagon stimulates production and release of glucose from glycogen stores in the liver leading to increased blood glucose levels
48
Q

History Assessment for Endocrine Disorders

A

because the endocrine system effects homeostasis and metabolic activity, the nurse must assess changes in nutritional status, physical appearance, weight, sleep pattern, energy, elimination pattern, and reproductive function
-as well as family history because some diseases are genetic

49
Q

Physical Assessment: Inspection of the patient

A

complete a head-to-toe assessment for endocrine disorders because physical appearance may be apparent

  • ex: patient with elevated levels of growth hormone (GH), a broadening of forehead or jaw may be noted
  • ex: elevated levels of cortisol, may note puffiness of the face
50
Q

Physical Assessment: Auscultation of the patient

A

auscultates the chest to assess cardiac rate and rhythm because some endocrine disorders affect cardiovascular function
-ex: hyperthyroidism, tachydysrhythmias may occur and may be auscultated
-ex: hyperthyroidism, because of the increased vascularity associated, the nurse also listens over the carotid arteries for carotid bruits
>direct auscultation over the thyroid gland may also reveal thyroid bruit with hyperthyroidism

51
Q

Physical Assessment: Palpation of the patient

A

to assess the testes and thyroid glands; both evaluated for size, symmetry, shape, and any nodules or changes in texture

52
Q

How to Palpate the Thyroid Gland

A

best palpated by standing behind the patient

  • the thumbs of both hands are placed on the back of the neck, and the fingers are curved to the front of the neck on either side of the trachea
  • the patient is asked to swallow, and the nurse locates the isthmus by feeling it rise when the patient swallows
  • the nurse assesses both the right and left lobes of the thyroid gland; the right lobe is palpated while the patients head is turned to the right, and assesses for irregularities or nodules; the left is similarly evaluated by having the patient turn the head to the left
  • The thyroid gland may also be assessed from the front; the nurse faces the patient and uses the thumbs or fingers to palpate each lobe of the thyroid gland
53
Q

Diagnostic Studies of Endocrine Disorders Include?

A
  • laboratory assessment of urine and blood glucose samples, imaging studies, and stimulation and suppression tests
  • the specific laboratory tests are associated with the disorder under investigation
54
Q

Stimulation Testing

A

a selected hormone is administered to stimulate the target tissue to produce its hormone
-failure of the target to secrete sufficient hormone indicates hypofunction of that gland

55
Q

Suppression Tests

A

indicated when there are excess levels of circulating hormone
-when levels of circulating hormone do not decrease with suppression testing, hyperfunction of the gland is confirmed

56
Q

Imaging Studies

A

indicated to assess for changes in size or presence of tumor formation in the glands of the endocrine system
-computed tomography (CT), magnetic resonance imaging, and x-rays are used to confirm abnormalities of the endocrine glands

57
Q

Age-related Changes

A

changes in endocrine function are associated with aging, and early detection and treatment can minimize long-term consequences

  • Menopause is an age-related change, but it is also a “normal state” of ovarian hormone deficiency that affects all women as they age; physiological changes caused by menopause are usually diminished with the use of hormone replacement therapy, but are growing concerns associated with these exogenous hormone replacements
  • age related changes can be secondary to hypoactive function of endocrine glands secondary to downregulation (decreased number of receptors on the surface of target tissue)
  • increased incidence of chronic disease
  • hormone production, secretion rates, and tissue responsiveness may all decrease with age
  • decreased metabolism
58
Q

Age-related Changes: Decreased Metabolism

A

associated with decreased appetite, susceptibility to cold intolerance, changes in the quality of sleep, and decreased resting pulse rate and blood pressure

59
Q

Age-related Changes: Reproductive hormones

A

changes in the release of reproductive hormones may lead to problems with sexual functioning, including erectile dysfunction and decreased libido

60
Q

Age-related Changes: Reduced anti-diuretic hormone

A

associated with increased urine frequency and dilute urine, leading to an increased risk of dehydration

61
Q

Age-related changes: Bone density

A

bone density decreases, thinning and drying of the skin, and perineal and vaginal dryness are associated with advanced age

62
Q

Laboratory Tests for Endocrine Disorders

A
  • Calcium
  • Ionized Calcium
  • Cortisol
  • Glucose
  • Magnesium
  • Phosphorus
  • Potassium
  • Sodium
  • Free T3 (triiodothyronine)
  • Total T3 (triiodothyronine)
  • Free T4 (thyroxine)
  • Total T4 (thyroxine)
  • Thyroid-stimulating hormone (TSH)
  • Urine Specific Gravity
  • Vitamin D
63
Q

Positive Feedback

A

when a product feeds back to increase its own production; This causes conditions to become increasingly extreme.
Ex: milk production by a mother for her baby.
>As the baby suckles, nerve messages from the nipple cause the pituitary gland to secrete prolactin. Prolactin, in turn, stimulates the mammary glands to produce milk, so the baby suckles more. This causes more prolactin to be secreted and more milk to be produced.

64
Q

What regulate metabolism?

A

the thyroid gland

65
Q

Important Assessment Findings in the Thyroid Gland

A
  • Mass
  • Enlarged Gland
  • Goiter
  • Asymmetrical Enlargement
  • Presence of Nodule or Bruit (related to increased blood flow)
66
Q

Normal Assessment Findings for the Thyroid Gland

A
  • Symmetrical movement swallowing
  • Adam’s apple more pronounced in Males
  • No Masses, tenderness, or enlargement
  • Absent or no Bruit
67
Q

Conditions that increase the secretion of TRH from the hypothalamus?

A

-low circulating T3 and T4
-cold and stress
>end result is increased metabolic activity

68
Q

Thyroid Gland Function Tests

A
  • Free T3 (triiodothyronine): 2.6-4.8 pg/mL
  • Total T3 (triiodothyronine): 70–204 ng/dL
  • Free T4 (thyroxine): 0.8–1.5 ng/dL
  • Total T4 (thyroxine): 4.6–12 mcg/dL
  • Thyroid-stimulating hormone (TSH): 0.5–8.9 micro international units (mIU)/mL
69
Q

Diagnostic Testing For Thyroid Gland

A
  • Thyroid Ultrasound
  • MRI
  • CT

Nursing 172 (120 decks)

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